Dr BS Rama Murthy, Consultant Radiologist, Srinivasa Ultrasound Scanning Centre and Chief Patron, Medical Ultrasound Society of Karnataka, Coordinator – Fetal Foundation of India, talks about the evolution of ultrasound and how foetal imaging has improved over the years, in an interaction with Express Healthcare
You have been practising foetal imaging for a long time. Can you shed light on the advancements in this field and how obstetric ultrasound has been a key modality in enhancing prenatal screening?
I am amongst the first radiologists who introduced the modality of ultrasound imaging into the country. Over the last 34 years, I have witnessed the steady technical advances in ultrasound. The ultrasound image of the foetus over the years has incredibly improved. For example, we started out looking at a few landmarks in the midline of the brain and today we have exquisite images which enable us to see the surface folds of the brain, the optic chiasma and so on. The foetal heart can be studied in great detail regarding the chambers, vessels and their connections. The spinal cord in the vertebral column can be seen very well. The abdominal organs and limbs can be seen. In the first 10 weeks of pregnancy, we can now see the embryologic developmental milestones. With the introduction of Doppler scanning, we are able to map the blood flow in the heart and the blood vessels of the foetus. With 3D and 4D, we are now able to display the foetal interiors in three planes simultaneously. Surface rendering helps us to create pictures of the face limbs etc.
Regarding screening, we should include diagnosis. With years of research, we are now able to screen for chromosomal abnormalities in the foetus, pre-eclampsia in the mother, premature labour and so on. Screening means using ultrasound imaging for the entire pregnant population to pick up certain findings called markers. Presence of a marker increases the risk of the abnormality. On the other hand, diagnosis implies determining normality or abnormality in a particular foetus.
How has ultrasound helped in improving pregnancy outcomes in patients?
When a lady undergoes ultrasound screening for chromosomal abnormalities and found screen positive, we recommend a definitive test to check for foetal chromosomes. If the foetus is found to be chromosomally abnormal, the parents have the option of termination of pregnancy. Similarly, if the pre-eclampsia screen is positive, the lady is put on aspirin and this improves the pregnancy outcome.
From a patient perspective, how has patient experience improved?
The greatest benefit that I see is for couples who have had foetal abnormalities in the previous pregnancy. Through ultrasound in subsequent pregnancies, we can show that the foetus is normal. This gives tremendous relief to the couple. Also, the couple is reassured on a routine basis that the foetus is normal.
What difficulties do you face concerning the sex determination act/policy in India? How have patients reacted to this and what kind of pressures have you faced?
The PC & PNDT Act is one of the best things to have happened in our country. This act points out that determining of foetal sex is against law. This is because this information was being used to selectively terminate female foetuses. The law prohibits this to prevent this inhumane practice. The law has imposed a set of rules and regulations to be followed by every hospital or diagnostic centre doing pregnancy ultrasound. Under this Act, we have to upload the case details on the same day for all the cases done during the day. This means additional work. Once we know what is expected of us by the act and once we comply with all the requirements there is no pressure. From the patient’s point of view, it means bringing a bonafide requisition slip and photo id.
Do you think fusion imaging (MRI and Ultrasound) may improve prenatal examination in future? What should radiologists know about fusion imaging?
Certainly yes. The prospects are exciting. If you are talking about fusion technique it has to be between ultrasound and MRI and not between any other two modalities. The penetration of ultrasound has been huge, for example, it has gained entry in the taluk levels whereas the MRI has not been able to gain entry and restricted to city limits. When you talk about fusion you need to have equal access to MRI and ultrasound to make the application a reality. At the moment it looks like a research technique. This can open up newer areas of research and we have to wait and watch.
From the technology point of view, what improvements you would like to see in ultrasound that can assist you in better patient outcomes in future?
There are two aspects to this. One is the technological advances happening in the machinery and this is a continuing process. The second aspect is that there is a lot of research happening across the world in this field and thanks to the Internet we are able to know about the good things and able to do our own research to contribute to the world research. We will wait for researches in the field of foetal imaging as well as technical advances in the future.
You have a long association with technology providers such as GE. So how has GE been a catalyst in enabling the progress in foetal imaging through its ultrasound technologies?
GE has been a leader in this front. Companies like GE not only provide us with the cutting-edge machines, they also help in disseminating the latest knowledge to facilitate clinical application of the technology. The company has some machines which are dedicated to the foetus. GE has been able to bring in a lot of innovation in various capabilities every year. They even follow up with clinical research and through webinars, conferences and exchange programmes, GE has been able to disseminate clinical research, thereby facilitating knowledge transfer.
How have you leveraged a partnership with industry players like GE to expand education?
Being a senior member of the profession, I am a committed teacher. Teaching helps me to learn. I participate in many of the educational initiatives of the company, be it workshops, webinars, lectures and so on.
This year, Wipro-GE completes 30 years in India. In your view, how have they impacted the healthcare ecosystem in this country?
Especially in ultrasound, they have made a great mark. The company has been able to bring in technology across the world at the same time be it in the US or in India. Their strength is in their support to their users in terms of up-gradation of technology and education.